A trial of telmisartan prevention of cardiovascular diseases (ATTEMPT-CVD): Biomarker study
A trial of telmisartan prevention of cardiovascular diseases (ATTEMPT-CVD): Biomarker study
复制标题
DOI：
10.1177/2047487315603221
复制
发表时间：
2016-06-01
影响因子：
8.3
通讯作者：
Sekigami, Taiji
中科院分区：
文献类型：
--
作者：
Ogawa, Hisao;Soejima, Hirofumi;Sekigami, Taiji
目的通过替米沙坦预防心血管疾病（ATTEMPT-CVD）试验，比较血管紧张素受体阻滞剂（ARB）治疗与非ARB标准治疗对高血压患者生物标志物水平变化及心血管事件发生率的影响。方法与结果在这项多中心、开放标签、随机、平行组、比较研究中，以降压治疗开始3年为主要终点，研究ARB治疗与非ARB标准治疗对尿白蛋白肌酐比（UACR）和血浆脑钠肽（BNP）水平变化的影响。比较两组心血管复合事件的发生率，并将事件发生率与生物标志物变化之间的关系作为次要终点进行研究。研究开始时，ARB组有615名患者，非ARB组有613名患者。与非ARB组相比，ARB组对UACR和血浆BNP水平变化有显著影响。ARB组发生的心血管事件较少，但差异无统计学意义。基线时UACR和血浆BNP水平与心血管事件相关。结论本研究首次证明，与非ARB治疗相比，ARB治疗导致血浆BNP升高幅度较小，而UACR下降幅度较大，且独立于血压控制，并对BNP和UACR作为抗高血压治疗中心血管和肾脏风险预测因子的意义提供了新的见解。
Aims A trial of telmisartan prevention of cardiovascular disease (ATTEMPT-CVD) was performed to compare the effects of angiotensin II receptor blocker (ARB) therapy and those of non-ARB standard therapy on biomarker level changes and the incidence of cardiovascular events in hypertensive patients.Methods and results In this multicenter, open-label, randomized, parallel-group, comparative study, the effects of ARB therapy and those of non-ARB standard therapy on urinary albumin creatinine ratio (UACR) and plasma brain natriuretic peptide (BNP) level changes were investigated for three years from the start of antihypertensive treatment as the primary endpoints. The incidences of cardiovascular composite events were compared between the two groups, and the relationship between the incidence of the events and biomarker changes were investigated as secondary endpoints. The study started with 615 patients in the ARB group and 613 patients in the non-ARB group. The ARB group had a significant effect on UACR and plasma BNP level changes compared with the non-ARB group. Fewer cardiovascular events occurred in the ARB group, but the difference was not statistically significant. UACR and plasma BNP levels at baseline were associated with cardiovascular events.Conclusion This study provided the first evidence that ARB treatment caused a smaller increase in plasma BNP and a greater decrease in UACR than non-ARB treatment, independently of blood pressure control, and gives a novel insight into the significance of BNP and UACR as predictors of cardiovascular and renal risk on antihypertensive treatment.